PrescribeIT® Specification and Guide Version 5.0

This resource is primarily used for the identification and definition of a medication. It covers the ingredients and the packaging for a medication.

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Usage Note: This is a unique id for the medication resource within the containing (medicationOrder). This is usually assigned by the sending application and is usually a GUID but can be any value.

Conformance Rule: This must begin with a # and contain the same id value that is referenced in the MedicationOrder.contained element.'

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element as much as possible.

The base language in which the resource is written.

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.

An Extension

• value @ url

Provides a textual description of the strength of the active ingredient(s) in the medication

Usage Note: When prescribing by chemical only (i.e. CCDD TM) the strength will be provided as either a discrete value or provided as part of the dosage instructions.

It is recommended that it be provided as a discrete field as it helps the pharmacy in selecting the correct product.

When prescribing by other levels (i.e. CCDD NTP, CCDD MP, DIN) the strength will be included as part of the drug name (Medication.code.text) but may also be here as a discrete field.

May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.

Conformance Rule: This element is used to represent the medication ordered or dispensed. A 'code' (Canadian Clinical Drug Data Set, or DIN or NPN) must be accompanied by 'text' when presribing. For compounds, a code is not used and the description will be sent as 'text'. A DIN, representative DIN or an NPN may also be used if a CCDD code is not available. This has an extensible binding meaning that the CCDD code system should be used but if a code is not available, vendors may also submit a code from the DIN or NPN code system. (Eventually CCDD will encompass all DINs and NPNs.)

Code systems that are acceptable in the message are:

CCDD - https://fhir.infoway-inforoute.ca/CodeSystem/canadianclinicaldrugdataset

DIN - http://hl7.org/fhir/NamingSystem/ca-hc-din

NPN - http://hl7.org/fhir/NamingSystem/ca-hc-npn

EMRs and PMSs must support sending and receiving all levels of drug terminology defined in the Canadian Clinical Drug Data (CCDD) Set including: Therapeutic Moiety (TM), Non-proprietary Therapeutic Product (NTP), Manufactured Product (MP) as well as Device NTP for devices. In cases where an appropriate Canadian Clinical Drug Data Set value is not yet available within the point-of-service system, the system can send a DIN or Natural Product Number (NPN) or a DIN with the (isRepresentative) value set to 'true'.

If no drug code (TM, NTP, MP, or DIN) is available in the point of service system, only then should the system send the drug name as text without a code. The pharmacy system must always display the textual name of the medication or non-medication provided in the message to the user when displaying the prescription. This represents the name of the medication or non-medication (e.g. device) as seen by the prescriber at the time of prescribing.

The pharmacy system may use the drug coding (TM, NTP, MP, DIN, NPN or representative DIN) to display to the user the list of products that can be dispensed.

In the context of the dispense notification, this conveys the product that what was dispensed.

unique id for the element within a resource (for internal references).

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

A reference to a code defined by a terminology system.

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Conformance Rule: Within ‘Coding’, ‘code’, 'system' and ‘display’ must be populated.

unique id for the element within a resource (for internal references).

An Extension

• value @ url

If set to true, indicates that the medication code sent was chosen as a "representative" code of a drug picked at a more general level. I.e. The user didn't actually choose this specific code. The intended constraints around what drug should be supplied are conveyed by the request's substitution rules.

Usage Note: Below the Grid View, we have provided a business scenario to provide further guidance and clarity on the intended use.

Conformance Rule: If prescribing by Generic Name, a (representative) DIN must be present in the message and this boolean must be 'true'.

Usage Note: PMS will ONLY interpret the ingredients from the representative DIN.

Usage Note: Upon receipt of a prescription, the PMS will look at this field. If 'true', then this is a representative DIN. The PMS my choose to use this as a means to automatically filter and present a list of possible DINs/ appropriate medication . The prescribed dosage (e.g. 20 mg) and route will also be considered. Once presented with a list, the pharmacist can select a medication from this list or may select another generic equivalent with the same prescribed dosage.

Usage in the EMR: The representative DIN is chosen by the EMR (not the prescriber) based on the drug and route that is entered by the prescriber.

Note: This concept does NOT exist today; pharmacists dispense based on the generic name. Its use within PrescribeIT® is to allow for automation as it provides a codified value to represent what the prescriber wants. This may assist the pharmacist in dispensing.

Conformance Rule: If the case where a prescriber selects a DIN and flags it as a representative DIN, the prescriber must also enter a strength and strength unit of measure and may optionally enter a prescription drug form.

The identification of the code system that defines the meaning of the symbol in the code.

Need to be unambiguous about the source of the definition of the symbol.

This is the URI that represents the coding system as defined within the binding.

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Need to refer to a particular code in the system.

This is the code as defined within the binding.

A representation of the meaning of the code in the system, following the rules of the system.

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Usage Rule: Generally, coding can be DIN, CCDD, or representative DIN. When the code is provided, then this value could be the display name from the terminology provider or display name as it was seen in the sending system by the prescriber (same value as sent in the Medication.code.text).

Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Conformance Rule: This must be displayed to the Pharmacist

Conformance Rule: Official name recorded and selected by the prescriber. This MUST be the name of the medication or non-medication as seen by the prescriber at the time of prescribing. This MUST be displayed to the pharmacist and MUST be stored as part of the electronic prescription. Note: If representative DIN was used, it is expected that this name will be the generic name, as selected by the prescriber.

Set to true if the item is attributable to a specific manufacturer.

Describes the details of the manufacturer.

Information that only applies to products (not packages).

Refer to child elements for detail

unique id for the element within a resource (for internal references).

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.

Usage Notes: The prescription drug form is optional to send to PrescribeIT® but is required in some provinces in order to meet the prescribing standards set out by the College of Physicians and Surgeons. As a result the EMR must support allowing the prescriber to send a prescription drug form when the drug form is not specified by the drug identifier (e.g. for compounds, drugs prescribed using a Therapeutic Moiety or Representative DIN).

Conformance Rule: A Code must be supplied if one is available from the PrescriptionDrugForm subset. If the user picks a prescription drug form that does not have a code in the PrescriptionDrugForm subset, only then can text be supplied without a code.

Identifies a particular constituent of interest in the product.

FUTURE USE ONLY: For compounds, only the textual description (supplied in Medication.code.coding.display) is mandatory. This will be used to convey pertinent information about the ingredients.

Note: If specified at some point in the future, the ingredients need not be a complete list; usually only active ingredients are listed.

unique id for the element within a resource (for internal references).

An Extension

• value @ url

Flag indicating whether the ingredient is active or inactive.

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

The actual ingredient - either a substance (simple ingredient) or another medication.

• type @ $this

A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.

FUTURE USE ONLY: This will be used in future to convey the individual codified ingredients contained within a compounded product for the purpose of identifying compounds that contain monitored ingredients (i.e. methadone powder).

Specifies how many (or how much) of the items there are in this Medication. For example, 250 mg per tablet.

FUTURE USE ONLY

unique id for the element within a resource (for internal references).

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

The value of the numerator.

FUTURE USE ONLY

The value of the denominator.

FUTURE USE ONLY: When used at some point in the future, this is the dosage unit or base quantity that contains the specified ingredient amount (e.g. 1 Tablet, 10ml)

Information about a group of medication produced or packaged from one production run.

unique id for the element within a resource (for internal references).

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

The assigned lot number of a batch of the specified product.

When this specific batch of product will expire.

Information that only applies to packages (not products).

unique id for the element within a resource (for internal references).

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

The kind of container that this package comes as.

A set of components that go to make up the described item.

unique id for the element within a resource (for internal references).

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Identifies one of the items in the package.

The amount of the product that is in the package.